Abstract

Background

A cluster randomised controlled trial (RCT) of a national Kenyan mental health primary
care training programme demonstrated a significant impact for health workers on the
health, disability and quality of life of their clients, despite a severe shortage
of medicines in the clinics (Jenkins et al.:37–47, 2012). In order to better understand
the potential reasons for the improved outcomes in the intervention group, the experiences
of the participating health workers were explored through qualitative focus group
discussions, as focus group methodology has been found to be a useful method of obtaining
a detailed understanding of client and health worker perspectives within health systems
(Sharfritz and Roberts. Health Transition Review 4:81-85, 1994).

Methods

Two ninety minute focus groups were conducted in Nyanza province, a poor agricultural
region of Kenya, with 10 health workers from the intervention group clinics where
staff had received the training programme, and 10 health workers from the control
group where staff had not received the training during the earlier randomised controlled
trial.

Results

These focus group discussions suggest that the health workers in the intervention
group perceived an increase in their communication, diagnostic and counselling skills,
and that the clients in the intervention group noticed and appreciated these enhanced
skills, while health workers and clients in the control group were both aware of the
lack of these skills.

Conclusion

Enhanced health worker skills conferred by the mental health training programme may
be responsible for the significant improvement in outcome of patients in the intervention
clinics found in the randomised controlled trial, despite the general shortage of
medicines and other health system weaknesses. These findings suggest that strengthening
mental health training for primary care staff is worthwhile even where health systems
are not strong and where the medicine supply cannot be guaranteed.